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Intermenstrual Bleeding

Definition

Vaginal bleeding (other than post coital) at any time in the cycle other than during normal menstruation

IMB  could indicate endometrial hyperplasia, fibroids, cervical pathology

 

Red Flag Symptoms

  • Postmenopausal Bleeding (PMB)i.e. bleeding >12 months after last period
  • ·         PMB in patients <55y who DO NOT have high risk factors (such as obesity and high BMI, who are on Tamoxifen, or are suffering from unexplained recurrent PMB) Refer to PMB Clinic
  • ·         PMB not in above group REFER TO GYNAE ON 2WW FORM
  • Persistent Intermenstrual bleeding (IMB)if >45y or other risk factors for endometrial cancer (eg obesity, PCOS unopposed estrogen, tamoxifen) –Refer urgently to the Menstrual Disorders Clinic
  • Suspicious cervix on examinationRefer to 2ww

 


Information to include in referral letter
 to The Menstrual Disorders Clinic

  • Describe problem and length of symptoms
  • Current contraception
  • Any current other hormonal treatment
  • Smear history (including last smear & result) the patient will still be seen without this but if you can retrieve it automatically it speeds up the consultation 
  • Relevant past medical / surgical history if not on proforma
  • Current regular medication if not on proforma
  • Speculum findings (eg normal / ectropion / cervicitis / cervical polyp)

 

 

Investigations prior to referral

  • Chlamydia screening
  • High Vaginal Swab
  • Pelvic USS
  • NB DON’T perform a cervical smear if outside the screening programme

 

Desirable Information 

  • Treatments tried so far if on hormonal contraception

 

 

References:

Intermenstrual and postcoital bleeding patient.co.uk website

NICE Guideline Jan 2007 Heavy Menstrual Bleeding